Inhalation sedation 2 Flashcards
What equipment is for inhalation sedation?
Stand alone unit
Piped in system
Gas cylinders
Piping
4 cylinders- 2x in use and 2x full
What colours are the gas cylinders and piping?
Oxygen is black and N2O is blue
What are the components of the piped in system?
-MDM head
-Active scavenging
What is the function of active scavenging?
For safety - helps reduce trace amounts of N2O from atmosphere
What are the features of a nasal mask?
They are:
-single use
-some are autoclaveable
What do you need to consider when choosing size of mask?
That you can achieve a good seal
What is the technique for inhalation sedation?
Standard techniques as per IACSD
Nitrous oxide with oxygen
Describe how equipment is checked?
Regular service every 6-12 months
Daily checks before use
Check tubing, and resevoir bag for rips, leaks, damage, tears
How is pt prepared for inhalation sedation?
Good pt selection is essential
let pt see amsk and try it on
consent before appt- need consent for sedation and dental treatment, if pt is a child-need adult with parental responsibility
Written info needs to be given in advance- info about sedation, preo op and post op info
Describe what is included in pre-sedation assessment?
-Full MH
-Prescribed and non prescribed drugs
-Any allergies
-Airway problems?
BMI
-ASA status
-Dental history
-Anxiety assessment
-Sedation and GA history
-SH- transport, escort, dependants
What are the pre-op instructions?
-Light meal 2hrs before appt
-No alcohol 24 hrs prior
-If pt is child- need responsible adult to accompany- with no other children
-Transport home- in a car or taxi
-Avoid bikes, trampolines, machinery, driving,
-Children(under 16) to be supervised by adult- ADULTS-undergoing inhalation sedation with N20/oxygen do not require an escort unless they have mobility issues or other indications
How to undergo dental treatment under inhalation sedation?
-Still need LA
-Good rapport
-Explain tx to pt
-stop signals
-gain trust
-consider into appt first/ appt with minimal tx
What are the pre op checks?
-Preop checks:
STAFF- sedationist, sedation trained nurse and another dental nurse
EQUIPMENT- Emergency and sedation
Preop pt checks:
Pt identification
planned dental procedure
Written consent
patent nose- no cold, cold, URTI
last emal/ drink / alcohol
MH
Pregnancy
Responsible adult
Transport arrangements
Signs of adequate inhalation sedation
Relaxed, warm feeling, tingling, lethargic/tired, dreamy, reduced gag reflex, STILL respond to questions, vital signs and reflexes intact
Process of administering inhalation sedation?
Fit appropriate size nasal mask
Make the pt comfortable
Place them semi supine or supine
100% O2 flow
Adjust flow rate 4-6l/min
Reservoir bag should expand with each breath
After a few mins. begin to titrate N2O in 10% increments per minute
When you get to above 30% N2O then give in 5% increments
Encourage pt to breathe through nose and minimise talking
once happy with level of sedation, start dental tx
Ineffective technique:
Nasal obstruction
mouth breathing (talking)
ineffective seal around nasal mask
pt resisting effects
too anxious
faulty equipment
How to monitor pts while sedated?
Monitor the pts clinical signs:
-level of consciousness/ level of sedation
airway patency
respiration rate and depth
(also non invasive bp checking may be indicated- eg in pts with CVD
Oversedation
pt may squint, complain of headache or nausea
How to deal with this:
Reduce N2O by 5-10%
reassure pt
monitor pt
if they recover then can continue
if severe then postpone tx
Recovery:
Once tx is complee reduce N2O to zero
Give 100% O2
Breathe for 3 mins
Remove nasal mask
Sit pt upright
Check they are not dizzy or nauseous
Check they can walk steadily
Post op instructions
Discharge
Discharge once happy pt has recovered
Give post op instructions
Record procedure
What to record for sedation procedure:
Dose, route, time(S) of adminstration of N2O
Details of cloinical monitoring (pre-op, after drug titration, intra op and post op plus any significant events)
Personnel present in surgery
Dental tx provided
pt recation, sedation score and success of sedation
Time of discharge
